So you have dental insurance… why doesn’t it cover all your treatments?
When most people think of insurance they think of their medical insurance. The biggest benefit they have with this type of coverage is that medical insurance not only pays for wellness visits but its major purpose is to help defray costs when it comes to catastrophic illness or accident.
Enter dental insurance.. and while medical disease can be both unpredictable and catastrophic the majority of dental aliments are preventable. Preventative care including routine check-ups and cleanings are paramount to maintaining good oral health. If you regularly visit your dentist problems can be diagnosed early and treated without need for extensive, elaborate, or expensive procedures. That theoretically keeps the cost of dental care much lower than those of medical care.
So what really are the differences?
• Medial Insurance is designed primarily to cover the costs of diagnosing, treating, and curing serious illness or care in case of an accident. This usually requires a family practice physician, numerous specialists and a variety of tests administered by doctors and labs, multiple procedures may be required and the then there is the need for medication.
• Dental Insurance works differently. Most plans are designed to make sure that patients receive regular preventive care. High dental care rarely requires the complex multiple resources often required by medical care. Because most dental disease is preventable by routine care dental benefits are structured to encourage patients to get regular routine care.
• Medical Insurance usually pays for the majority of tests, operations, lab work etc. needed to diagnose and treat disease. The exception is some brand new technologies or experimental treatments.
• Dental Insurances are designed to cover only a portion of the total cost of a patients necessary dental needs when faced with treatment beyond the normal preventive care. For example your dentist may recommend a crown for a badly decayed tooth while your insurance may only pay for a filling, your dentist may recommend an implant for a diseased tooth but your plan will only pay for a bridge.
The second difference between the 2 types of insurance are important to expand on. If the patient has not maintained routine dental care and is now faced with extensive dental needs, they are presented with the choice- to accept the treatment planned as outline by their dentist and pay money out of their pocket to cover the treatment or only go forward with the treatment that is covered by insurance.
This leaves both the patient and the dentist in a bit of a pickle. The dentist wants to treat the disease that the patient is faced with so that it doesn’t get worse or cause any more serious problems. The patient on the other hand is asking the dentist to only preform those treatments that are covered by their insurance which may not be the preferred solution to the problem. Or they may have multiple teeth that require care and ask that only certain teeth are treated and then will wait until the next year’s dental benefits kick in.
The decision to not move forward with the recommended treatment usually leads to more extensive and expensive procedures. The patient may even be putting their health in jeopardy while delaying treatment. (this subject will be covered in upcoming posts)
The question you should ask yourself when making the decision to move forward with dental treatment not reimbursed by your dental plan is this, if you were presented with the fact that you had heart disease and your insurance did not pay for all of your treatment would you risk serious complications by only accepting the treatment covered by insurance or follow your physicians recommendation for treatment?
Maintaining a healthy mouth is important for a number of reasons. Many diseases such as diabetes, oral cancer and cardiovascular disease can be first detected in the mouth by a comprehensive oral exam. The team at Advanced Dentistry is committed to preventing dental disease before it becomes a major problem, and we are here for you if you are in need of more extensive treatment. We are a non-judgemental zone and improving your oral health is our mission.
While your eyes may be the window to your soul, your mouth is the gateway to optimal health and well-being.
Our staff is ready to help you with all you insurance questions, call us today 732 356-9120
Next week – frequently asked questions about dental insurance coverage.